The Dutch guideline on the diagnosis and treatment of varicose veins recommends that the ‘C’ from the North American Venous Forum classification CEAP (‘C’ = clinical, ‘E’ = aetiological, ‘A’ = anatomical, and ‘P’ = pathophysiological classification ) be recorded in the clinical case notes and that traditional tests as described by Trendelenburg and Perthes be omitted as they are of no use in patients with C2 and C3 varicose veins.
In primary C1, C2 and C3 varicose veins that have not previously been treated, a handheld Doppler may be used to exclude reflux. If reflux is found or if in doubt, duplex investigation is necessary.
Before any invasive treatment of C2 or C3 varicose veins is scheduled, duplex investigation of the superficial and deep systems is mandatory. In C2 and C3 varicose veins functional investigations such as plethysmography and intravenous pressure measurement are superfluous.
With respect to treatment of an insufficient greater saphenous vein, stripping from knee to groin with side branch interruption in the groin is the gold standard in the treatment of C2 and C3 varicose veins.
Endovenous techniques such as radio frequency ablation or laser are comparable with the classical stripping method in the treatment of C2 and C3 varicose veins
Insufficient perforating C2 or C3 veins in these patients need no specific treatment.
Prior to surgery the entrance level of the lesser saphenous vein into the popliteal vein should be marked with the patient lying in supine position and with the aid of duplex.
For patients with side-branches hook needle extraction through mini- incisions is the treatment of choice.